The Role of Antibiotics in the Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Outpatient Setting

Abstract

Chronic obstructive pulmonary disease (COPD) is an illness characterized by progressive respiratory symptoms and frequent exacerbations. Acute exacerbations of COPD (AECOPD) are mostly treated in the outpatient setting and the use of antibiotics for this patient population remains controversial. This thesis aimed to explore the role of antibiotics in the outpatient management of AECOPD through two studies. The first study was a systematic review of randomized controlled trials examining the impact of antibiotics on the outcome of treatment failure in outpatients with AECOPD. Meta-analysis was conducted using both frequentist random effects and Bayesian analyses. The second study was a secondary analysis of a prospective cohort of patients with AECOPD discharged from the emergency department. The association between antibiotic treatment and the outcome of rehospitalization within 14 days of discharge was examined using logistic regression and propensity score matched analyses. In the systematic review and meta-analysis, both frequentist random effects and Bayesian analyses revealed a high likelihood of benefit for antibiotics. In the secondary analysis, there was no association between treatment with antibiotics and rehospitalization however due to a small sample size and a low event rate, there was considerable risk of Type II error. Overall, when considering the results of these two studies in the context of previous literature, treatment with antibiotics likely provides a modest benefit in the outpatient management of AECOPD.